Provider Demographics
NPI:1871875690
Name:MELLO, TAMARA B (LCPC-C)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:B
Last Name:MELLO
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 SCHOOL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-7518
Mailing Address - Country:US
Mailing Address - Phone:207-458-7491
Mailing Address - Fax:207-274-2999
Practice Address - Street 1:2 SCHOOL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-7518
Practice Address - Country:US
Practice Address - Phone:207-458-7491
Practice Address - Fax:207-274-2999
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional